Alteplase
- Class: Thrombolytic
- Used for: acute stroke or heart attack
- Say it: AL-teh-plays
- Forms: injection
ALTEPLASE wakes up PLASMIN, the body's own clot-eater — the PLAS is right there in the name.
It activates plasminogen to plasmin, which digests fibrin that has already set. Every other clot drug only prevents; this one dissolves.
Every other clot drug stops new clot forming. Alteplase is a plasminogen activator — it turns on the body's own clot-dissolving enzyme and breaks down the fibrin that has already set.
Side effects
Common: bleeding at puncture sites, bruising
Serious: brain hemorrhage, angioedema
Typical dose
0.9 mg/kg in stroke, maximum 90 mg
Weight-based: 10% as a bolus, the rest over 60 minutes. CT must exclude haemorrhage first.
Check yourself
What makes alteplase fundamentally different from heparin or rivaroxaban?
- It breaks down a clot that has already formed, rather than preventing new ones
- It works on platelets rather than on fibrin
- It is given by mouth
- It blocks vitamin K
Show answer
A. It breaks down a clot that has already formed, rather than preventing new ones
Anticoagulants and antiplatelets are preventive — they stop a clot growing or forming. Alteplase activates plasminogen to plasmin, which digests existing fibrin. That is also why its bleeding risk is in a different league.
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